颈前路椎体次全切减压融合钛网植骨内固定术治疗双节段脊髓型颈椎病中远期随访

发布时间：2018-06-13 01:04

本文选题：钛网 + 植骨融合　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:回顾并分析颈前路椎体次全切减压钛网植骨融合内固定术治疗双节段脊髓型颈椎病的中远期疗效。方法:回顾并分析2008年1月~2011年12月间,皖南医学院第一附属医院弋矶山医院里采用颈前路椎体次全切减压融合植骨内固定术治疗双节段脊髓型颈椎病患者43例,男29例,女14例,年龄39~74岁,平均(56.3±12.7)岁,术前病程3~36个月,病变椎体:C3-5节段11例,C4-6节段16例,C5-7节段16例。43例患者完成完成了术前和术后及随访的影像学检查及临床问卷调查,根据患者术前、术后,末次随访时腰背痛手术评分标准(Japanese Orthopedic Assoeiation JOA)、颈椎生理弯曲与锥间高度的变化来评估其术前、术后及随访时患者的肢体功能障碍恢复情况及神经压迫缓解情况。结果:所有患者均完成获随访,平均随访2.9±1.23年。未出现内固定位置松动、断裂及脱落,腰椎无畸形、序列恢复良好。手术后及末次随访患者神经症状有明显缓解,所有患者术前术后JOA评分术前平均8.5±1.4分,术后JOA评分12.5±1.3分,末次JOA评分14.5±1.3分。患者术前术后JOA评分差异有统计学意义(P0.05);末次随访与术前JOA评分差异有统计学意义(P0.05),神经改善率优良率83.72%,性别差别对术后神经改善率无影响,年龄大小及病程长短影响患者术后神经改善率,且患者年龄及病程越长,术后疗效越差。患者术后颈椎生理曲度较术前有明显恢复,患者术前术后颈椎生理弯曲差异有统计学意义(P0.05),末次随访与术前颈椎生理弯曲差异有统计学意义(P0.05),而且患者术后椎间高度较术前有明显改善。结论:对颈前路椎体次全切减压融合钛网植骨内固定术治疗双节段颈椎病进行了回顾性的研究,根据患者术前、术后,末次随访时腰背痛手术评分标准(Japanese Orthopedic Assoeiation JOA)、颈椎生理弯曲与锥间高度的变化证实了,颈前路椎体次全切减压融合植骨内固定术能够明显改善双节段脊髓型颈椎病患者神经功能,稳定颈椎及恢复颈椎生理弯曲度及椎间高度,而且中远期疗效明显。
[Abstract]:Objective: to review and analyze the mid-and long-term effect of anterior cervical vertebra subtotal decompression and titanium mesh fusion and internal fixation for two-segment cervical Spondylotic Spondylotic Spondylotic Disease. Methods: from January 2008 to December 2011, 43 patients (29 males) with two-level cervical Spondylotic myelopathy were treated by anterior cervical subtotal decompression and fusion with bone graft fixation in the first affiliated Hospital of Southern Anhui Medical College. 14 women (3974 years old, mean 56.3 卤12.7) years old. The course of disease was 3 ~ 36 months before operation. 16 cases of C4-6 segment, 16 cases of C5-7 segment and 16 cases of C5-7 segment had completed the imaging examination and the clinical questionnaire survey before and after operation, including 16 cases of C4-6 segment and 16 cases of C5-7 segment. Preoperative, postoperative, and final follow-up of patients with low back pain (LBP) was evaluated according to Japanese Orthopedic Assoeiation JOAA, changes in cervical curvature and height between cones. Recovery of limb dysfunction and remission of nerve compression after operation and follow-up. Results: all patients were followed up with an average of 2.9 卤1.23 years. No internal fixation position loosening, fracture and shedding, no malformation of lumbar vertebrae, and good sequence recovery. The neurologic symptoms of all the patients were relieved after operation and the last follow-up. The JOA scores were 8.5 卤1.4, 12.5 卤1.3 and 14.5 卤1.3, respectively. The difference of JOA score before and after operation was statistically significant (P 0.05), the difference between the last follow-up and the preoperative JOA score was significant (P 0.05), the rate of nerve improvement was 83.72%, and the difference of sex had no effect on the rate of postoperative nerve improvement. Age and duration of disease affect the rate of postoperative nerve improvement, and the longer the patient's age and course, the worse the postoperative effect. The physiological curvature of cervical vertebrae recovered significantly after operation. There were significant differences in the preoperative and postoperative physiological curvature of cervical vertebrae (P 0.05), and there was a significant difference between the last follow-up and preoperative cervical curvature (P 0.05), and the postoperative height of cervical vertebrae was significantly improved compared with that before operation. Conclusion: a retrospective study was carried out on the treatment of two-segment cervical spondylosis by anterior cervical subtotal decompression and fusion with titanium mesh and internal fixation. At the last follow-up, Japanese Orthopedic Assoeiation JOAA, cervical vertebra physiological bending and interconical height changes confirmed that anterior cervical anterior subtotal decompression and fusion bone graft internal fixation can significantly improve the neurological function of patients with two-segment cervical spondylosis. To stabilize the cervical spine and restore the physiological curvature and intervertebral height of the cervical vertebrae, and the mid-and long-term effect is obvious.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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